Feasibility of basic transesophageal echocardiography in hemorrhagic shock: potential applications during resuscitative endovascular balloon occlusion of the aorta (REBOA)

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

There are numerous studies in the cardiovascular literature that have employed transesophageal echocardiography (TEE) in swine models, but data regarding the use of basic TEE in swine models is limited. The primary aim of this study is to describe an echocardiographic method that can be used with relative ease to qualitatively assess cardiovascular function in a porcine hemorrhagic shock model using resuscitative endovascular balloon occlusion of the aorta (REBOA).

Methods

Multiplane basic TEE exams were performed in 15 during an experimental hemorrhage model using REBOA. Cardiac anatomical structure and functional measurements were obtained. In a convenience sample (two animals from each group), advanced functional cardiovascular measurements were obtained before and after REBOA inflation for comparison with qualitative assessments.

Results

Basic TEE exams were performed in 15 swine. Appropriate REBOA placement was confirmed using TEE in all animals and verified with fluoroscopy. Left ventricular volume was decreased in all animals, and left ventricular systolic function increased following REBOA inflation. Right ventricular systolic function and volume remained normal prior to and after hemorrhage and REBOA use. Mean ejection fraction (EF) decreased from 64% (S.D. 9.6) to 62.1 (S.D. 16.8) after hemorrhage and REBOA inflation ( p = 0.76); fractional area of change (FAC) decreased from 49.8 (S.D. 9.0) to 48.5 (S.D. 13.6) after hemorrhage and REBOA inflation ( p = 0.82).

Conclusion

Basic TEE, which requires less training than advanced TEE, may be employed by laboratory investigators and practitioners across a wide spectrum of experimental and clinical settings.

Related collections

Most cited references 18

Record: found
Abstract: found
Article: found

Resuscitative endovascular balloon occlusion of the aorta (REBOA) in the pre-hospital setting: An additional resuscitation option for uncontrolled catastrophic haemorrhage.

Samy Sadek, David J Lockey, Robbie A Lendrum … (2016)

This report describes the first use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the pre-hospital setting to control catastrophic haemorrhage. The patient, who had fallen 15 meters, suffered catastrophic internal haemorrhage associated with a pelvic fracture. He was treated by London's Air Ambulance's Physician-Paramedic team. This included insertion of a REBOA balloon catheter at the scene to control likely fatal exsanguination. The patient survived transfer to hospital, emergency angio-embolization and subsequent surgery. He was discharged neurologically normal after 52 days and went on to make a full recovery. The poor prognosis in catastrophic torso haemorrhage and novel endovascular methods of haemorrhage control are discussed. Also the challenges of Pre-Hospital REBOA are discussed together with the training and governance required for a safe system.

0 comments Cited 45 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Use of resuscitative endovascular balloon occlusion of the aorta in a highly lethal model of noncompressible torso hemorrhage.

Jonathan J Morrison, James D Ross, Robert Houston … (2014)

Noncompressible torso hemorrhage is a leading cause of death in trauma, with many patients dying before definitive hemorrhage control. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct than can be used to expand the window of salvage in patients with end-stage hemorrhagic shock. The aim of this study was to evaluate the effect of continuous and intermittent REBOA (iREBOA) on mortality using a highly lethal porcine model of noncompressible torso hemorrhage. Male splenectomized pigs (70-90 kg) underwent a laparoscopic liver injury (80% resection of left lobe) followed by a 10-min free-bleed period. Animals were then divided into three groups (n = 8) for a 60-min intervention phase (n = 8): continuous occlusion (cREBOA), iREBOA, or no occlusion (nREBOA). Groups then underwent whole blood resuscitation, damage control surgery, and further critical care. Endpoints were mortality and hemodynamic and circulating measures of shock and resuscitation. Systolic blood pressure (in mmHg) at the end of the free-bleed period for cREBOA, iREBOA, and nREBOA was 31 ± 14, 48 ± 28, and 28 ± 17, respectively (P = 0.125). Following the start of the intervention phase, systolic blood pressure was higher in the iREBOA and cREBOA groups compared with the nREBOA (85 ± 37 and 96 ± 20 vs. 42 ± 4; P < 0.001). Overall mortality for the cREBOA, iREBOA, and nREBOA groups was 25.0%, 37.5%, and 100.0% (P = 0.001). Resuscitative endovascular balloon occlusion of the aorta can temporize exsanguinating hemorrhage and restore life-sustaining perfusion, bridging critical physiology to definitive hemorrhage control. Prospective observational studies of REBOA as a hemorrhage control adjunct should be undertaken in appropriate groups of human trauma patients.

0 comments Cited 39 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

A novel fluoroscopy-free, resuscitative endovascular aortic balloon occlusion system in a model of hemorrhagic shock.

Todd Rasmussen, Liam J. Morrison, H Eliason … (2013)

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a potentially lifesaving maneuver in the setting of hemorrhagic shock. However, emergent use of REBOA is limited by existing technology, which requires large sheath arterial access and fluoroscopy-guided balloon positioning. The objectives of this study were to describe a new, fluoroscopy-free REBOA system and to compare its efficacy to existing technology. An additional objective was to characterize the survivability of 60 minutes of REBOA using these systems in a model of hemorrhagic shock. Swine (70-88 kg) in shock underwent 60 minutes of REBOA using either a self-centering, one component prototype balloon system (PBS, n = 8) inserted (8 Fr) and inflated without fluoroscopy or a two-component, commercially available balloon system (CBS, n = 8) inserted (14 Fr) with fluoroscopic guidance. Following REBOA, resuscitation occurred for 48 hours with blood, crystalloid, and vasopressors. End points included accurate balloon positioning, hemodynamics, markers of ischemia, resuscitation requirements, and mortality. Posthemorrhage mean arterial pressure (mm Hg) was similar in the CBS and PBS groups (35 [8] vs. 34 [5]; p = 0.89). Accurate balloon positioning and inflation occurred in 100% of the CBS and 88% of the PBS group. Following REBOA, mean arterial pressure increased comparably in the CBS and PBS groups (81 [20] vs. 89 [16]; p = 0.21). Lactate peaked in the CBS and PBS groups (10.8 [1.4] mmol/L vs. 13.2 [2.1] mmol/L; p = 0.01) 45 minutes following balloon deflation but returned to baseline by 24 hours. Mortality was similar between the CBS and PBS groups (12% vs. 25%, p = 0.50). This study reports the feasibility and efficacy of a novel, fluoroscopy-free REBOA system in a model of shock. Despite a significant physiologic insult, 60 minutes of REBOA is tolerated and recoverable. Development of lower profile, fluoroscopy-free endovascular balloon occlusion catheters may allow proactive aortic control in patients at risk for hemorrhagic shock and cardiovascular collapse.

0 comments Cited 38 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

William A. Teeter: teeterw@gmail.com

Bianca M. Conti: bconti@som.umaryland.edu

Phil J. Wasicek: pwasicek@som.umaryland.edu

Jonathan J. Morrison: jonathan.morrison@umm.edu

Dawn Parsell: DParsell@som.umaryland.edu

Bryan Gamble: redsox5287@gmail.com

Melanie R. Hoehn: melanie.rose.hoehn@emory.edu

Thomas M. Scalea: tscalea@umm.edu

Samuel M. Galvagno Jr:

ORCID: http://orcid.org/0000-0001-5563-4092

sgalvagno@som.umaryland.edu

Journal

Journal ID (nlm-ta): Cardiovasc Ultrasound

Journal ID (iso-abbrev): Cardiovasc Ultrasound

Title: Cardiovascular Ultrasound

Publisher: BioMed Central (London )

ISSN (Electronic): 1476-7120

Publication date (Electronic): 16 July 2018

Publication date PMC-release: 16 July 2018

Publication date Collection: 2018

Volume: 16

Electronic Location Identifier: 12

Affiliations

[1 ]ISNI 0000 0001 1034 1720, GRID grid.410711.2, University of North Carolina, ; Raleigh, North Carolina USA

[2 ]ISNI 0000 0001 2175 4264, GRID grid.411024.2, Department of Anesthesiology, Division of Trauma Anesthesiology, , University of Maryland School of Medicine, ; Baltimore, MD USA

[3 ]ISNI 0000 0001 2175 4264, GRID grid.411024.2, Department of Surgery, , University of Maryland School of Medicine, ; Baltimore, MD USA

[4 ]ISNI 0000 0001 2175 4264, GRID grid.411024.2, Department of Surgery, Program in Trauma, , University of Maryland School of Medicine, ; Baltimore, MD USA

[5 ]GRID grid.420176.6, Department of Surgery, , Walter Reed National Medical Center, United States Army, ; Bethesda, MD USA

[6 ]ISNI 0000 0001 0941 6502, GRID grid.189967.8, Department of Surgery, , Emory University, ; Atlanta, GA USA

[7 ]University of Maryland, Program in Trauma, Baltimore, MD USA

[8 ]ISNI 0000 0001 2175 4264, GRID grid.411024.2, Department of Anesthesiology, Divisions of Critical Care Medicine and Trauma Anesthesiology, , University of Maryland School of Medicine, ; Baltimore, MD USA

Author information

Samuel M. Galvagno Jr http://orcid.org/0000-0001-5563-4092

Article

Publisher ID: 129

DOI: 10.1186/s12947-018-0129-8

PMC ID: 6048745

PubMed ID: 30012168

SO-VID: 34362940-f298-4cc7-a7fe-ac8089aa1dba

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 22 March 2018

Date accepted : 25 June 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000182, Medical Research and Materiel Command;

Award ID: W81XWH-16-1-0116

Award Recipient : Thomas M. Scalea

Custom metadata

ScienceOpen disciplines: Cardiovascular Medicine

Data availability:

ScienceOpen disciplines: Cardiovascular Medicine

Feasibility of basic transesophageal echocardiography in hemorrhagic shock: potential applications during resuscitative endovascular balloon occlusion of the aorta (REBOA)

Read this article at

Abstract

Background

Methods

Results

Conclusion

Related collections

Cardiovascular Innovations and Applications

Most cited references 18

Resuscitative endovascular balloon occlusion of the aorta (REBOA) in the pre-hospital setting: An additional resuscitation option for uncontrolled catastrophic haemorrhage.

Use of resuscitative endovascular balloon occlusion of the aorta in a highly lethal model of noncompressible torso hemorrhage.

A novel fluoroscopy-free, resuscitative endovascular aortic balloon occlusion system in a model of hemorrhagic shock.

Author and article information

Contributors

Journal

Affiliations

Author information

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 375

Cited by 1

Most referenced authors 239